Professionals Against Child Abuse

PACA has Early Day Motion in the House of Commons put forward by Daniel Kawczynski

“General Medical Council Complaints System - 10-06-2008

That this House believes that the General Medical Council’s (GMC) complaints mechanism fails to comply with standards of fairness and due process required by Article 6 of the European Convention on Human Rights; observes that the GMC’s role in investigating, prosecuting and sentencing falls below the standard required of an independent and impartial tribunal; notes that in practice the GMC represents the interest of parents in cases where doctors suspect abuse; further notes that children themselves have no independent representation to present a doctor’s concerns; further believes that no published guidelines appear to guide prosecution decisions and that, as prosecutor, the GMC amends and adds charges in an ad hoc fashion; considers that doctors are uncertain of the allegations they face, compromising their ability to mount a cogent defence; further considers that the GMC calls expert witnesses with clear conflicts of interest in the proceedings who are unrepresentative of mainstream practice or opinion, and that the GMC adopts a populist, punitive, deterrent and disproportionate approach to sentencing; further considers that the GMC’s apparently arbitrary admission and exclusion of evidence extends to ignoring the findings of previous investigations into a case conducted by an accused doctor’s employer; further believes that the GMC values the public perception and integrity of the profession above individual rights; and further observes that, contrary to basic principles of justice, the GMC appears to assume the guilt of doctors before it, and refuses to acquit when a conviction is impossible, instead finding ‘no realistic prospect of prosecution’.”

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Article cited with kind permission of onmedica.com

A recent OnMedica poll of 589 doctors has found that 74% disagree with the General Medical Council’s decision to remove paediatrician David Southall from the medical register.

Dr Southall was struck off the register in December 2007 after being found guilty by the GMC of serious professional misconduct. The GMC decided Prof Southall’s conduct in a case where he accused a mother of drugging and murdering her son was an abuse of position and fundamentally incompatible with his continuing as a registered medical practitioner.

At the time of the ruling, the Royal College of Paediatrics and Child Health spoke out against the GMC’s decision, and paid tribute to the major contribution to child health made by Dr Southall during a distinguished career.

Kamran Abbasi, CEO of OnMedica, said: “The GMC was criticised for its decision at the time of the ruling. This poll proves that a large majority of doctors agree that Dr Southall should not have been struck off. It is important that doctors are not deterred from undertaking child protection work.”

It is becoming clear that children remain at risk if they do not have the protection and advocacy of professionals. There has been an increase in violent crime against children according to figures from the NHS as published in the Observer, April 20 2008 by Jo Revill, Whitehall editor.

Observer article: http://www.guardian.co.uk/society/2008/apr/13/childprotection.health

There are many reasons for this, but it is the view of PACA that one major contributory factor is the increasing reluctance of doctors and other professionals to risk bringing concerns about child abuse to light for fear of condemnation and censure. The Guardian has published an article about this “climate of fear” (April 13 2008 by Gaby Hinsliff, political editor) which has arisen consequent to the GMC actions against Southall, Meadow and San Lazaro. The consequence of this “climate of fear” may be that in another 5 years we will see a further tragic rise in assaults on children.

Guardian article: http://www.guardian.co.uk/society/2008/apr/20/children.nhs

The GMC feel that this is not their responsibility and continue to repeat the same reassurances about numbers of paediatricians brought to fitness to practice hearings. PACA feels that the GMC figures do not reflect the true impact of the high profile cases; nor do their statements reflect the RCPCH work on this subject, as evidenced by the numerous unfilled child protection consultant posts.

The Guardian article, whilst being very helpful in highlighting many of the concerns that PACA seeks to publicise, has been challenged by David Southall. Southall’s concerns relate to details of Finlay Scott’s statement and some assumptions made in the text of the article. He has written a letter to the Guardian explaining this which was not published but reads as follows:

In Harm’s Way - Article published in The Financial Times, April 7 2008
Writer: Margaret McCartney

Child protection is not a medical speciality for the faint-hearted. The people doing this work, typically paediatricians who have undergone focused training, can be subjected to abusive language, threatening telephone calls and worse. The tragedy is that child-protection work should be necessary at all, though of course it is, and doctors, nurses and social workers must all be aware of it.

Read the full article: In harm’s way?

Bearing Good Witness: The Reluctant Experts, by Catherine Williams, Reader in Law, Sheffield University
[Republished with publisher’s permission]

“In October 2006 the government launched a consultation document, Bearing Good Witness: Proposals for reforming the delivery of medical expert evidence in family law cases. The consultation closed in February 2007 and a summary of responses was published in July 2007. Prior to that, in a parliamentary statement on 17 June 2004, the Minister for Children, Young People and Families indicated that she had arranged for the Chief Medical Officer (CMO) to carry out an inquiry into how best to ensure the availability and quality of medical expert resources in court proceedings because there was an ‘acute problem … in finding experts of high standing to give medical evidence in proceedings’. She did not explain why this situation had arisen nor did she address the more acute problem. The unavailability of expert witnesses in proceedings is a symptom of the widespread reluctance of paediatricians, in particular, but also other professional staff, to be involved in child protection work in any respect. That reluctance was and is having a serious detrimental effect on the current arrangements for the protection of vulnerable children generally and will ensure that the narrower area of interest, that of experts being appointed for a specific purpose, will become even more difficult for want of the availability of sufficiently experienced professionals. The executive summary of Bearing Good Witness sets out the factors that, in the opinion of the CMO, deter doctors from being expert witnesses:

• few training programmes;

• court processes intimidating and stressful;

• court processes slow, bureaucratic and time consuming; and

• fear of referral to the General Medical Council (GMC) by vexatious parties.”[…]

To read the full article, please download it here

Letter 1: Open letter to the General Medical Council
In Views & reviews, BMJ 2007;335:1265 (15 December), doi:10.1136/bmj.39427.640069.DE

Dear Professor Catto,

I am writing to you as a designated doctor for child protection. As part of my responsibilities I am required to offer advice and guidance to doctors within my area about child protection matters. Unfortunately, in the light of the recent verdict against Professor David Southall, I feel I cannot fulfil that role responsibly; to do so would put both my and their registration at peril. We urgently need guidance.

I have struggled through the available transcripts of the 33 day hearing which culminated in this judgment. The judgment found that David Southall had inappropriately accused a mother of murdering her 10 year old child. Much of the case hinges on a complaint made by a Mrs “M.” As you are doubtless aware, there have been many such complaints made over the years against Dr Southall, almost all of which are linked to an energetic and committed, but deeply misguided campaign largely run by Penny Mellor. It is perhaps worth noting the commentary on her activities given by Mr Justice Whitburn, in sentencing her to two years imprisonment for her part in the abduction of a child: “Impervious to debate, convinced that you are right, you have traduced, complained about and harried dedicated professional people working in this difficult area. … What is unforgivable is the way in which you manipulated for your own, as I find, purposes, the genuine distress of the [XXXX] family.” The complainant in this case claimed minimal involvement with Mrs Mellor, though Mrs Mellor had contacted her.

It is also unsurprising that the complaints—along with Mrs Mellor’s obsessional interest—started around Professor Southall’s groundbreaking work using the technique of covert video surveillance. Using this technique, Professor Southall demonstrated beyond any possible doubt a very uncomfortable truth: that apparently normal, “loving” parents could and did inflict the most horrific and life threatening abuse on their helpless infants when they thought they were not being observed. To many, including many doctors and sadly even paediatricians, the emotional impact of this truth has been so great that they have retreated into a variety of forms of denial. It is, however, significant that, to my knowledge, not a single one of Professor Southall’s detractors has yet given any cogent explanation of how he or she would have dealt differently with these extremely difficult cases and still protected the lives of the children involved. Notably, one such detractor, Professor David,1 was the only expert witness called by the GMC in both this hearing and in the previous hearing, in which the GMC reviewed David Southall’s involvement in the Sally Clark case. He can hardly be claimed to be suitable as the only expert used at the hearing in the circumstances.

So incensed were Mrs Mellor and her associates, however, that over the years their campaign has grown to encompass almost every aspect of David Southall’s professional career. No stone has been left unturned, and his career has been examined in a detail that few doctors’ practices have ever been before. As a result of complaints generated by Mrs Mellor and her group, he has been subjected to at least 20 inquiries into his conduct and practice, including one into this very complaint, by a panel far better qualified and more competent than your own on child protection issues. North Staffordshire NHS Trust issued a public statement saying that there was no case to answer on any of the complaints. Your organisation is the only one to have found any serious deficiencies in his practice or conduct.

Which brings me back to your hearing. Fundamentally, Mrs M’s complaint relates to events in a closed room in a hospital in Stoke-on-Trent in 1998. There were three people in this room: Mrs M, Professor Southall, and Francine Salem, a senior social worker. Ms Salem made handwritten notes at the time which were clearly quite comprehensive, and which Mrs M accepted at the hearing as an accurate account of the meeting. These notes, and her sworn evidence given over three days at your hearing, clearly show Professor Southall acting entirely appropriately and professionally. Mrs M, however, claimed an almost diametrically opposing scenario, despite accepting that Ms Salem’s notes were accurate.

This leaves me, and the doctors I must advise, in an impossible position. If faced with a situation of possible child abuse, we could ignore it, contrary to all morality, good practice, government, and even your own guidance. This would obviously be wrong, but the evidence suggests that we are unlikely seriously to be sanctioned by your body for such dereliction of duty. Or we could, following good practice guidelines, raise our concerns with the child’s parents. Last week’s ruling, however, shows that even having the best of witnesses will not protect us against increasingly probable complaints. The message your body has sent out is loud and clear: challenge parents at your peril, you will have no conceivable defence.

But sadly it does not end with such dramatic undermining of good practice. From April next year, the government expects us to take part in a review of all children’s deaths. Reviewing the death of a child was what Professor Southall was doing here. It is clear that this important piece of government policy cannot operate while the GMC regulates any part of it. If uncorrected, the inevitable consequence of the incompetence of your Fitness to Practice Panel is that regulation of all “Safeguarding Children” matters must be withdrawn from you.

by R Wheatley, consultant community paediatrician, designated doctor for child protection. Child Development and Family Support Centre, Blackpool

Competing interests: RW worked alongside David Southall’s department in Stoke-on-Trent for about one month, as a registrar in paediatrics, and has been involved is research projects run by him.

References
-David TJ. Spying on mothers. Lancet 1994;344:133.[ISI][Medline
-BMJ 2008;336:231 (2 February), doi:10.1136/bmj.39471.702141.3A

Letter 2: Open letter to the General Medical Council
In Letters, BMJ 2008;336:232 (2 February), doi:10.1136/bmj.39472.786690.BE

How many doctors are referred for child protection work?

Catto’s analysis (previous letter) in response to Wheatley’s open letter needs comment.1 He must accept that the GMC’s decision about Meadow was incorrect. The High Court overturned the GMC’s decision, stating that the GMC’s judgment “approached the irrational.” The Court of Appeal confirmed the High Court’s action.2 Perhaps Catto would like to state that it was the GMC that erred.

Some readers may not realise that the eight paediatricians that Catto says were referred to the fitness to practise procedures were only a fraction of those actually referred to the GMC. The fitness to practise procedure is not the start of the GMC process but is a hurdle along the route. It would be useful if Catto told us exactly how many senior paediatricians had been referred to the GMC because of their work in child protection. A survey by the Royal College of Paediatrics and Child Health in 2004 reports that 86 complaints about 76 doctors were referred to the GMC, albeit over a longer time period.3
Paediatricians were shocked when Meadow was struck off. The actions against Southall have greatly increased that alarm because Southall seemed to be doing exactly what he should according to the government guidelines and indeed the GMC’s own advice. Paediatricians need the support and understanding of the GMC, but the GMC must understand the difficulties and complexities of child protection and must not be a tool for understandably aggrieved parents. Its judgment must be based on the principle that the needs of the child are paramount. The GMC must be competent to understand the paediatrician’s action from the point of view of the child.

by Leonard H P Williams, consultant paediatrician
Bassetlaw District General Hospital, Worksop S81 0BD

Competing interests: None declared.
References
• Wheatley R. Open letter to the General Medical Council. BMJ 2007;335:1265. (15 December.)[Free Full Text]
• Meadow v GMC [2006] EWCA Civ 1390
• Royal College of Paediatrics and Child Health. Child protection complaint survey. London: RCPCH, 2004.

Letter 3: Open letter to the General Medical Council

GMC statement does not reflect actions

Catto says that nothing could be further from the truth than the perception that the General Medical Council (GMC) is somehow determined unfairly to persecute paediatricians involved in child protection work (second letter). However, although the GMC made a similar response to the Guardian in April after our article in Pediatrics,1 2 a recent GMC panel in David Southall’s case produced a perverse and erroneous determination.3 We do not consider therefore that the GMC’s statement is yet reflected in its actions.

The GMC’s actions have included:

A failure to acknowledge that it was wrong in stating that Meadow’s “conduct was fundamentally incompatible with what is expected by the public from a registered medical practitioner,” given that Mr Justice Collins considered this conclusion “approached the irrational”

A failure to recognise that Meadow’s professional activity was about child protection—he was called as a witness in the criminal case because of his expertise in sudden infant death and infant suffocation, having been an internationally acclaimed expert in the recognition of fabricated and induced illness.

A determination in 2004 that Southall’s confidential contact with the police over a child’s safety was “precipitate,” reflecting a lack of understanding of the doctor’s and, indeed, the public’s duty to child protection.

A determination in 2007 that the testimony of an aggrieved parent that Southall had accused her of murder was to be believed to a criminal standard of proof over the combined testimonies of Southall and the senior social worker present at the interview, despite information available to the GMC and its panel which questioned the mother’s reliability as a witness.

A failure to recognise that a substantially more robust investigation by Southall’s employing trust six years earlier had found no basis for this allegation (first letter)4.
Using fitness to practise panels where the members, medical experts, and legal assessors have little understanding of the Children Act or of the roles of doctors in child protection and are therefore not qualified to judge the actions of doctors working in the child protection system.

Undertaking investigations into the conduct of a number of other doctors acting in child protection cases which have been either inappropriate, unduly prolonged, or a repeat of an investigation already undertaken either by an employing authority or other agency with statutory functions in child protection
Failing to have a policy and process for dealing with vexatious complainants.

Both Meadow and Southall are internationally acclaimed experts in fabricated and induced illness who have been targeted to discredit the recognition of this form of serious child abuse. We have seen these two doctors vilified in the media while the GMC undertakes prolonged investigations to support the orchestrated complaints against them. Even some members of parliament consider fabricated and induced illness a discredited theory. Yet paediatricians and others in child protection regularly recognise and manage such cases.

Professionals Against Child Abuse (PACA) was not set up to create a perception that there is a problem with the regulatory system for doctors. It was formed only recently as a response to the problems that the GMC’s actions are causing for doctors in their child protection work. Our professional duty is to ensure the effective protection of children. Although we welcome the GMC’s recent 0-18 years’ guidance, we do not see representation of the child’s voice in the actions of the GMC against doctors who have acted in good faith on behalf of vulnerable children.

by John Bridson, chair
Professionals Against Child Abuse, Childhealth Advocacy International, Nottingham NG1 5BB

On behalf of Professionals Against Child Abuse (PACA) (www.paca.org.uk)
Competing interests: None declared.
References
• Williams C. United Kingdom General Medical Council fails child protection. Pediatrics 2007;119:800-2.[Abstract/Free Full Text]
• Boseley S. Guardian 2007 2 Apr. www.guardian.co.uk/society/2007/apr/02/childrensservices.uknews
• Wheatley R. Open letter to the General Medical Council. BMJ 2007;335:1265. (15 December.)[Free Full Text]
• Hall DMB. How to investigate complaints. bmj.com 2007. www.bmj.com/cgi/eletters/335/7632/1265#187703.

Article republished with permission from onmedica.com

Author: Dr Heather Payne, consultant paediatrician

Child Protection work is demanding, sensitive and often difficult, and generates much anxiety for all concerned – children, parents, and all professionals including Paediatricians.

If, like me, you deal with child protection matters on a daily basis, you probably, like me, spend a fair bit of time reflecting on how the process works, and whether it does what it says on the tin. It’s not protecting children to remove them from non-abusive parents. Neither is it protecting them to leave them with abusive ones. There are many things we know we don’t know, like the EXACT significance of fingertip bruising, or of a simple skull fracture attributed to a fall.

The truth is that some of these injuries will be accidental, but some will be NAI, and it can be extremely difficult to get it right in every case. Err in one direction, and a baby goes home to further risk of abuse and may come back dead. Err in the other direction, and enormous distress is caused by unnecessary hospitalisation of the child or removal to foster care.

Until recently, I had confidence that the Child Protection process, (based on many years of ‘Working Together’ [1] with Social Services, Police and other colleagues highly skilled in this field) would protect both me and the children it was put in place to serve. The deal, reinforced by the Laming Report [2], is this: when you see a child who MAY have suffered NAI, but you are not sure, then use the Child Protection procedures to involve other eyes and ears, share information and come to a collective decision about the risk to the child. I felt that there was safety in numbers (decisions taken with professional colleagues), and that this appropriate use of the ‘medical model’ would mean I could express concerns and get answers to tough questions like ‘Is it safe for this bruised child to be in this household tonight or should we remove to a safer place?’

But my illusion of safe practice has been shattered by two recent GMC decisions [3] about professional practice relating to the Paediatrician Dr David Southall. In direct opposition to the Laming recommendations, the GMC have adjudged that David Southall was wrong to share his concerns about a high profile child abuse case when he did not have the full information. But this is precisely what we are obliged to do under all Child Protection procedures, which use words to the effect that ‘if you have concerns that a child MAY be suffering abuse you MUST refer’. This reflects the reality, often called the ‘jigsaw of child protection’ that no individual has all the pieces, but requires the help of others to get the full picture.

When there is concern about abuse, it is vital to assess the risk to the child of remaining at home. This is especially the case when a child has died and there is therefore a risk to any other children of the household. High stakes and high pressure assessments are the name of this game. However hard I try to maintain professional calm, and however carefully I choose my words, it’s not unusual for stressed parents to construe my precise but neutral questions about how the child came by their injury as ‘an accusation that they have battered their child’. I had always thought that the presence of a social work colleague would protect me from this becoming a substantiated complaint, but the GMC have now discounted the stories of David Southall and a senior Social Worker who took contemporaneous notes, and believed a parent’s accusation that David Southall accused her of murder. He has been struck off and the protection I thought I had which allowed me to do this difficult work as well and conscientiously as I can, without the worry of losing my job, is no longer there.

Nobody wants to get it wrong in Child Protection. Children’s lives and happiness are at stake in the short term. But in the longer term, the average Paediatrician is already walking away [4] from work in areas where they feel they are a sitting duck for those who would ‘shoot the messenger’. Courts delays in child care cases due to the lack of Paediatricians willing to provide Expert Witness reports are already directly affecting the lives of children and their families.

The rock of Child Protection work and the hard place of these GMC decisions [5] has led to this situation. The rock will not go away, so the hard place needs to examine itself and see whether its decisions are justified and really serve children, or whether the GMC has fallen into the first trap of child protection that we warn trainees about – always listen to what the child is telling you rather than just the parent.

References

1 HM Government 2006 Working Together to Safeguard Children http://www.everychildmatters.gov.uk/resources-and-practice/IG00060

2 Lord Laming 2003 The Victoria Climbie Inquiry http://www.victoria-climbie-inquiry.org.uk/finreport/finreport.htm

3 Chadwick DL, Krous HF, Runyan DK. Meadow, Southall, and the General Medical Council of the United Kingdom. Pediatrics 2006;117:2247-2251

4 Haines L, Turton J. Complaints in Child Protection. Arch.Dis.Child. 2008;93:4-6.

5 Williams, C. United Kingdom General Medical Council Fails Child Protection. Pediatrics 2007;119:800-802

Published in Sentinel, 20 December 2007

As A junior doctor in 1998, and a person who has worked at North Staffordshire NHS Trust, and also an established whistleblower regarding the sub-standard care of acutely ill people at the trust, I have no reason to support the old boys’ network. But I would simply like to say that Professor David Southall was always well regarded by his patients and colleagues. Relatives who had met him and his colleagues would also speak highly of him. A patient relative once told me how kind he had been to her family. It was this description of overt kindness that struck me and the lady’s testimony has remained with me. Although I have never met Professor Southall, I have followed the last 10 years in depth, and independently came to the conclusion that he is a good doctor, who has been cut in his prime by a minority group. He has also survived the last 10 years due to his own strength of character. I know a number of people who have been subjected to harassment by the same group, and not tolerated the abuse at all. It seems that doctors no longer have the same rights as average citizens. Having had dealings with the campaign group against Dr Southall, I found that their concerns have not been based on sound evidence. Those who know the GMC through the Shipman Inquiry and the Public Policy Institute will know that the GMC has flawed systems. The GMC decision means that child protection is at considerable risk and no doctor can rely on the testimony of a third party or chaperone. None of the complaints against him have been made by those unrelated to this minority group. There are many families in Stoke-on-Trent who are brave people. There are many relatives to have suffered. This group does not consist of brave parents. Mike Wolfe is ill-informed on the workings of child protection and I invite him to familiarise himself with the documentation before putting pen to paper.??I hope Professor Southall is successful in his appeal.

DR RITA PAL

West Midlands